Слайд 2Pancreatic cancer occurs when changes (mutations) in the pancreas cells lead them
![Pancreatic cancer occurs when changes (mutations) in the pancreas cells lead them](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-1.jpg)
to multiply out of control. A mass of tissue can result. Sometimes, this mass is benign (not cancerous). In pancreatic cancer, however, the mass is malignant (cancerous).
Слайд 3There are two types of tumors that grow in the pancreas: exocrine
![There are two types of tumors that grow in the pancreas: exocrine](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-2.jpg)
or neuroendocrine tumors. About 93% of all pancreatic tumors are exocrine tumors, and the most common kind of pancreatic cancer is called adenocarcinoma. Pancreatic adenocarcinoma is what people usually mean when they say they have pancreatic cancer. The most common type begins in the ducts of the pancreas and is called ductal adenocarcinoma.
The rest of the pancreatic tumors — about 7% of the total — are neuroendocrine tumors (NETs), also called pancreatic NETs (PNETs), an islet cell tumor or islet cell carcinoma. Some NETs produce excessive hormones. They may be called names based on the type of hormone the cell makes — for instance, insulinoma would be a tumor in a cell that makes insulin.
Слайд 6Risk factors for pancreatic cancer include the following
Smoking
Obesity
Personal history of diabetes or
![Risk factors for pancreatic cancer include the following Smoking Obesity Personal history](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-5.jpg)
chronic pancreatitis
Family history of pancreatic cancer orpancreatitis
Certain hereditary conditions
Слайд 7Symptoms
Most patients present with pain (in the back) weight loss or jaundice
Tumors
![Symptoms Most patients present with pain (in the back) weight loss or](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-6.jpg)
in the head of the pancreas are more likely to have jaundice,
Those that arose in the body or tail, more likely pain and weight loss.
Слайд 8Bile: yellowish fluid produced in the liver that aids in digestion of
![Bile: yellowish fluid produced in the liver that aids in digestion of](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-7.jpg)
fat in the small intestine
Слайд 9Bile: passes through the common bile duct through the head of the
![Bile: passes through the common bile duct through the head of the](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-8.jpg)
pancreas on it's way to the duodenum
Слайд 10Bile duct carries the bilirubin through the head of the pancreas on
![Bile duct carries the bilirubin through the head of the pancreas on](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-9.jpg)
it's way to the duodenum
Слайд 11Tumors in the head of the pancreas are more likely to have
![Tumors in the head of the pancreas are more likely to have jaundice](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-10.jpg)
jaundice
Слайд 12Tumors in the head of the pancreas are more likely to have
![Tumors in the head of the pancreas are more likely to have jaundice](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-11.jpg)
jaundice
Слайд 14Tumors in the body or tail are more likely to present with
![Tumors in the body or tail are more likely to present with pain or weight loss](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-13.jpg)
pain or weight loss
Слайд 15Symptoms of Pancreas Cancer
Asthenia (weakness) 86 percent
Weight loss 85 percent
Anorexia (no
![Symptoms of Pancreas Cancer Asthenia (weakness) 86 percent Weight loss 85 percent](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-14.jpg)
appetite)-83 percent
Abdominal pain - 79 percentEpigastric pain (stomach)-71 percent • Dark urine-59 percent
Jaundice 56 percent
Nausea 51 percentBack pain - 49 percent
Diarrhea- 44 percent
Vomiting-33 percent
Steatorrhea (fatty stools)- 25 percent
Thrombophlebitis - 3 percent
Слайд 16Signs of Pancreas Cancer
Jaundice (yellow) - 55 percent
Hepatomegaly (large liver) - 39
![Signs of Pancreas Cancer Jaundice (yellow) - 55 percent Hepatomegaly (large liver)](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-15.jpg)
percent
Right upper quadrant mass - 15 percent
Cachexia (wasting) 13 percent
Courvoisier's sign (nontender but palpable distended gallbladder at the right costal margin) 13 percent
Epigastric mass (fell lump in stomach) - 9 percent
Ascites (abdominal fluid) - 5 percent
Слайд 17Pathology
Ductal adenocarcinoma accounts for about 85% of all neoplasms. And more
![Pathology Ductal adenocarcinoma accounts for about 85% of all neoplasms. And more](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-16.jpg)
than 95% of all pancreatic cancers arise from the exocrine (digestive enzymes) elements.Cancers that arise from the endocrine cells (neuroendocrine, islet cells) account for 5% or less
Слайд 19Cancer in the Head of the Pancreas
![Cancer in the Head of the Pancreas](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-18.jpg)
Слайд 20Location of Pancreas Cancer
60 to 70 percent of exocrine pancreatic cancers are
![Location of Pancreas Cancer 60 to 70 percent of exocrine pancreatic cancers](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-19.jpg)
localized to the head
20 to 25 percent are in the body/tail and the remainder involve the whole organ
H = Head
N = Neck
B = Body
T = TailUn Uncinate
Слайд 21Tests used to evaluate and stage pancreas cancer
Routine blood tests e.g. liver
![Tests used to evaluate and stage pancreas cancer Routine blood tests e.g.](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-20.jpg)
products like bilirubin
Elevated tumor markers (CA 19-9 or CEA)
MRI, CT scans, Ultrasound
Endoscopy including endoscopic ultrasound or ERCP
LaparoscopyBiopsy
Слайд 22CA 19-9
The reported sensitivity and specificity rates of CA 19-9 for pancreatic
![CA 19-9 The reported sensitivity and specificity rates of CA 19-9 for](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-21.jpg)
cancer range from 70 to 92, and 68 to 92 percent, respectively.The rates of unresectable disease among all patients with a CA 19-9 level ≥130 units/mL versus <130 units/mL were 26 and 11 percent, respectively. Among patients with tumors in the body/tail of the pancreas, more than one-third of those who had a CA 19-9 level ≥130 units/mL had unresectable disease.
Слайд 23Elevated CA 19-9
Cancer
Pancreas
Biliary Cancer (gallbladder, cholangiocarcinoma,ampullary)- Hepatocellular
Gastric, ovarian, colorectal (less often)
Lung,
![Elevated CA 19-9 Cancer Pancreas Biliary Cancer (gallbladder, cholangiocarcinoma,ampullary)- Hepatocellular Gastric, ovarian,](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-22.jpg)
breast, uterus (rare)
Benign
Acute cholangitis
- Cirrhosis and other cholestatic diseases (gall stones)
Слайд 24Ultrasound
study of 900 patients who underwent ultrasound to work up painless jaundice,
![Ultrasound study of 900 patients who underwent ultrasound to work up painless](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-23.jpg)
anorexia, or unexplained weight lossThe sensitivity for detection of all tumors in the pancreas was 89 percent Among the779 patients who were followed over time and established not to have developed a pancreatic tumor, nine had false-positive US findings (specificity 99 percent).
Слайд 25Mass in the pancreatic head and dilated common bile duct and pancreatic
![Mass in the pancreatic head and dilated common bile duct and pancreatic duct](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-24.jpg)
duct
Слайд 26CT
Sensitivity of CT for pancreatic cancer depends on technique and is highest
![CT Sensitivity of CT for pancreatic cancer depends on technique and is](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-25.jpg)
(89 to 97 percent) with triple-phase, helical multidetector row CTAs expected, sensitivity is higher for larger tumors; in one study, the sensitivity was 100 percent for tumors >2 cm, but only 77 percent for tumors ≤2 cm in size
Слайд 28ERCP or Endoscopic retrograde cholangiopancreatography
![ERCP or Endoscopic retrograde cholangiopancreatography](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-27.jpg)
Слайд 30ERCPInject dye into the duct system and look for compression
![ERCPInject dye into the duct system and look for compression](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-29.jpg)
Слайд 31ERCP
Sensitivity of 92 percent and Specificity of 96 percent for diagnosing cancer
![ERCP Sensitivity of 92 percent and Specificity of 96 percent for diagnosing](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-30.jpg)
of the pancreas by ERCPERCP provides an opportunity to collect tissue samples(forceps biopsy, brush cytology) for histologic diagnosis.However, the sensitivity for detection of malignancy (approximately 50 to 60 percent) is lower than that of endoscopic ultrasound (EUS)-guided FNA (sensitivity 92 percent)
Слайд 40Stage IB (T2NOMO) over 2cm, limited to pancreas
![Stage IB (T2NOMO) over 2cm, limited to pancreas](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-39.jpg)
Слайд 41Stage IIA (T3N0) beyond the pancreas
![Stage IIA (T3N0) beyond the pancreas](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-40.jpg)
Слайд 43Stage III (T4) Unresectable Cancer has spread to the major blood vessels
![Stage III (T4) Unresectable Cancer has spread to the major blood vessels](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/1182495/slide-42.jpg)
near the pancreas. These include the superior mesenteric artery, celiac axis, common hepatic artery, and portal vein.